The Global Fund exists to end the epidemics of Human Immuno-deficiency Virus (HIV), tuberculosis and malaria while strengthening resilient and sustainable systems for health .Nigeria is a major contributor to the fund. The Guardian’s investigation revealed that Nigeria has been accessing funding support from Global Fund since 2002 through the Country Coordinating Mechanism (CCM) comprising wide range of stakeholders including government of Nigeria; and that NACA is one of the three principal recipients for the HIV grant . The current grant runs from July 2015 to June 2017.

 

A copy of the Global Fund Audit Report by the Office of the Inspector General (OIG) of the Nigeria Grant obtained from the website of the Global Fund identified systemic weaknesses in the Nigeria’s HIV and malaria grants, indicting NACA and NMEP. The OIG safeguards the assets, investments, reputation and sustainability of the Global Fund by ensuring that it takes the right action to accelerate the end of AIDS, tuberculosis and malaria. The audit report on Nigeria covered $889 million of Global Fund grants, and found systemic weakness in the controls in various government entities. The investigation examined the work of a sub-recipient, Department of Health Planning, Research & Statistics of Federal Ministry of Health (DPRS-FMoH) and found evidence of systematic embezzlement, and identified $3.8 million of irregular spending.

 

The systemic weaknesses identified by the audit report included: weak monitoring of health commodities from Global Fund Pooled Procurement Mechanism at the Federal Medical Stores, Oshodi, Lagos State; ineffective inventory management and distribution of commodities from Federal Medical Stores to health facilities; expiry of HIV commodities and non-destruction of expired drugs; inadequate control of procurement processes through the procurement agent which handled procurement of commodities on behalf of NACA; poor quality of reported data owing to ineffective data collection and reporting; and alleged embezzlement and misappropriation of fund by the DPRS-FMoH.

 

But the Director General of NACA, Prof. John Idoko, in his presentation on the OIG findings made available to The Guardian noted: “Despite these challenges, the grant from the Global Fund is making public health impact on people living with HIV and the health system and will continue to do so as the systematic issues raised by OIG requiring policy and strategic actions are receiving urgent attention by the Government of Nigeria, the NACA. “Despite improvements at national level, inadequate capacity and lack of motivation of staff at health facilities involved in the programme has remained a huge challenge to effective grant implementation as a lot of the health workers at the facilities complain of unpaid salaries for months in some states. “The agency and Federal Ministry of Health are working out effective strategies to address these systemic challenges.”

 

Idoko said one of the strategies under consideration is the introduction of electronic medical record (EMR) system in Global Funds’supported secondary facilities to improve overall data quality. He said other remedial actions taken by NACA include: strengthening of the procurement unit with the deployment of a deputy director from the Bureau of public procurement as head of procurement at the agency; re-organisation of NACA Global Fund Team as a dedicated unit focused on Global Funds grant management; decentralisation of global fund commodity storage and management to eight zonal stores renovated with funding from Global Fund; and support to Logistics Management Coordination Unit in 36 states and the Federal Capital Territory.

 

Idoko said NACA had advised government at state and Local Government Area (LGA) levels to effectively play its role as the grant is implemented in secondary and primary health facilities owned and managed by it to improve overall quality of the programme and other public health programmes in Nigeria. The National Coordinator of NMEP, Dr. Nnenna Ezeigwe, told The Guardian she had received a letter from the Global Funds expressing some concerns, which the FMoH was addressing. Meanwhile, the OIG investigation, which began in late 2014 after a spot check from the Global Fund’s Local Fund Agent (LFA), PricewaterhouseCoopers, and the Fiscal Agent, GFA Consulting, identified forged and missing expenditure documents.